Healthcare Provider Details

I. General information

NPI: 1821499187
Provider Name (Legal Business Name): RITE AID OF PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BLAIR STREET
HOLLIDAYSBURG PA
16648
US

IV. Provider business mailing address

200 NEWBERRY COMMONS
ETTERS PA
17319-9363
US

V. Phone/Fax

Practice location:
  • Phone: 814-696-0289
  • Fax: 814-695-8241
Mailing address:
  • Phone: 717-975-5937
  • Fax: 717-975-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ZOREK
Title or Position: SR MA NAGER PROVIDER ENROLLMENT
Credential:
Phone: 717-975-5937